The Prevalence of Gender-Diverse Youth in a Rural Appalachian Region

Gender-diverse youth (GDY) are those whose gender identity and sex assigned at birth do not align. This group has demonstrated health disparities, including increased depression and suicidality compared with non-GDY.1 The prevalence of this population is largely unknown, especially in rural areas like the Appalachian region, where youth already face long-standing health inequities.2 A prior study3 exploring the prevalence of gender diversity among youth in the Appalachian state of West Virginia estimated that roughly 1% identified as transgender but did not collect data from youth themselves. In 2017, the Youth Risk Behavior Survey (YRBS) asked a nationally representative sample of youth if they identified as transgender, and found that 1.8% of US high school students responded affirmatively.1 Many GDY do not identify with the word transgender, potentially underestimating the true prevalence of gender diversity.4 Recently, a more inclusive 2-step question was included in the Pittsburgh YRBS and found that 9.2% of youth reported an incongruence between their gender identity and sex assigned at birth.4 The current study sought to assess the prevalence of GDY in a rural region in Appalachia.